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Archives for December 2016

Do I Need an Emergency Dentist for Wisdom Teeth?

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I wonder if I need to see an emergency dentist. My wisdom teeth hurt so much I can’t even eat. Plus, they’re swollen. I’ve had them get swollen before, but this seems worse than normal.

Celeste – Cincinnati, Ohio

Dear Celeste,

The important things about wisdom teeth are how they come in and how much space is available for them. Wisdom teeth can be problematic because there generally isn’t a lot of room for them. They push the other teeth out of the way and by shifting everything, it becomes difficult to clean between all the teeth. It’s also very hard to keep wisdom teeth clean, especially when they’re still partially covered by the gums. Sometimes, the gums will lift up just enough to allow food and bacteria in and it becomes trapped. This can result in localized infections and tooth decay,

“Normal” pain from wisdom teeth can manifest itself in a lot of ways. Sometimes all the teeth in the arch hurt because they’re all being pushed. Other times, it’s localized to the one area. People may also experience sinus, jaw, and ear pain, among other things.

You didn’t mention whether you’re already under the care of a general dentist. If so, they should likely have recommended you have your wisdom teeth taken out due to the recurrent pain. However, now that you’re noticing warning signs like swollen gums, it sounds like it could be turning into an infection.

Also, if the pain is so bad that you can’t eat, something is very wrong. Either of these symptoms scream for an emergency dentist. If you don’t have a general dentist who can get you in soon. If it’s an infection, you need to be seen today.

This blog is brought to you by Dr. Raymond Bolt.

Why Do My Son’s Fillings Keep Falling Out?

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My son just turned five and the pediatric dentist noticed he had three cavities at his last visit. This was surprising because I brush his teeth for him most days, but we went ahead and had the fillings done anyway. About a week after the fillings were done, one fell out. We went back and the doctor replaced it. Within a week, another one fell out, and while we were waiting for the appointment, the one he’d just replaced fell out. I’ve lost all faith in him at this point. How can I be sure the fillings are being done right this time around, or do I need to take my son to a different pediatric dentist? There aren’t a whole lot of dentist in my area who will only do white fillings, so it’s difficult to find someone new. I’d like to work with the one we have, if I can be sure he’ll get it done right, but I’ll start looking for someone new if I need to.

April

Dear April,

It sounds like you’ve got your heart set on doing composite (tooth-colored) fillings. This is fine, as a lot of people are trying to find mercury-free solutions these days, but the fillings work on different principles.

When a doctor places a silver (amalgam) filling one, he shapes the preparation so it has a groove in it. That way, when the amalgam dries, it gets locked into place. Composite fillings work almost like a glue. The surface is etched and then the composite is bonded to it. Even a tiny  bit of moisture missed in during this bonding process will destroy the bond, which is why a lot of dentists prefer to use amalgam when they’re working on back teeth or helping wiggly children.

Without knowing the full situation and having a proper exam, it’s difficult to assess what’s happening with certainty, but a likely culprit is moisture causing these fillings to fail. The pediatric dentist should have warned you if he thought moisture would be a problem. With adults, you can usually work around this and take steps to keep the tooth dry during the procedure. Doctors generally use a mixture of cotton rolls, air, and dental dams to isolate the area they’re working on. Kids, especially little ones, have the tendency to fight this kind of stuff. They’ll move around in the chair, push their tongue into the preparation, and they aren’t typically fond of dental dams. So, when you get to the point where a parent really wants the white filling and the child can’t cooperate enough to keep it dry, sedation during the procedure becomes the next solution.

With adults, you can usually work around this and take steps to keep the tooth dry during the procedure. Doctors generally use a mixture of cotton rolls, air, and dental dams to isolate the area they’re working on. Kids, especially little ones, have the tendency to fight this kind of stuff. They’ll move around in the chair, push their tongue into the preparation, and they aren’t typically fond of dental dams. So, when you get to the point where a parent really wants the white filling and the child can’t cooperate enough to keep it dry, sedation during the procedure becomes the next solution.

There is a solution. You could try sedation dentistry. It’s perfectly safe for use with children and will enable your son to get a white filling without the wiggles that can make it so hard to deal with the moisture issue.

This blog is brought to you by Dr. Raymond Bolt.